Doctors, patients caught in middle of narcotics ‘epidemic’As the number of prescriptions for narcotic painkillers has increased over the last several years, doctors “are in the sight of the gun,” said Dr. Farris Keeling, a family practice physician at Essentia Health who specializes in treating chronic pain.
By: Brandon Stahl and MaryJo Webster, Duluth News Tribune and St. Paul Pioneer Press
As the number of prescriptions for narcotic painkillers has increased over the last several years, doctors “are in the sight of the gun,” said Dr. Farris Keeling, a family practice physician at Essentia Health who specializes in treating chronic pain.
The primary way to get those painkillers is from doctors, and as more addiction, overdoses and deaths from those drugs have
occurred, “we’re being blamed for this epidemic,” Keeling said.
“We’re trying hard to respond to our part of the problem, which is: It’s easier for a junior high school kid in Duluth to get a Lortab at school than a beer or cigarette. That is terribly scary,” he said. “I can’t come up with a horrible enough word. That feeling as a doctor, to be aware of that and to know that some of that came from your prescription pad, is awful.”
Doctors like Keeling are among the doctors and health-care leaders working to try to reduce the number of prescribed opiates diverted and abused, pushing efforts like mandatory drug screening for high-risk patients, requiring patients to sign contracts that say they won’t abuse the drugs if they’re prescribed, and working to create a prescription monitoring program.
But the battle isn’t an easy one. A joint News Tribune and St. Paul Pioneer Press analysis found that the amount of opiates being prescribed and abused in the state is higher than it’s ever been, leading to a record amount of people being admitted for treatment for opiate addiction.
One of the difficulties in reducing those numbers, said Keeling, is that doctors got into the profession to care for patients, not to figure out which ones are trying to scam them.
“We’re not here to be police,” he said.
Getting pills ‘was easy for me’
Cordero Steverson’s addiction to narcotic pain pills started when he was 15.
The 24-year-old Minneapolis native said he had connections to nurses who would bring pills to him and other friends.
“It was easy for me because I didn’t have to spend money,” he said during an August interview at Teen Challenge in Duluth, where he was a patient. “I could do them how I normally do: crush them down, sniff them up. Pop ’em. Sell some. And the thing about it was, not only was just people my age who were 15, it was 10-year-olds, 11-year-olds out there popping pills. It was crazy.”
When that supply ran out, he said he’d go to doctors and hospitals and get the drugs.
He has since dropped out of the Teen Challenge program, and administrators say they don’t know how he is doing.
St. Luke’s emergency room in Duluth sees patients who try to scam doctors out of narcotic painkillers on a daily basis, said Dr. Nick Van Deelan, director of the hospital’s emergency medicine department.
Van Deelan said trying to determine who is and isn’t trying to abuse narcotics is one of the most difficult challenges his department faces.
Most doctors, he said, want to give patients the benefit of the doubt
“We feel that part of our job is to relieve pain, and we want to do that,” he said. “And we also know that we’re mandated to first do no harm. If somebody is here for addiction for diversion purposes, we feel that’s a significant harm. And trying to sort out which one is which is difficult.
“There are patients who have legitimate pain problems … and they get frustrated because they feel that because of this epidemic we’re experiencing, they aren’t able to get the pain medication or the treatment they really need.”
‘A chilling effect’
Van Deelan said a tool he frequently uses to catch people who are doctor-shopping is the Minnesota Prescription Monitoring Program, created in 2009 by the state Legislature. It requires pharmacies to make daily entries into a state database whenever narcotics are prescribed.
But in practice, it’s unclear how successful the program has been. Prescribers and pharmacies aren’t required to check the database whenever a patient has a prescription filled. And data provided by the Minnesota Board of Pharmacy, which administers the program, shows that only 26 percent of eligible prescribers and 23 percent of pharmacists are registered to use the program.
The program only logs prescriptions in Minnesota, so doctors can’t check to see if patients are going to neighboring states.
Cody Wiberg, the head of the Minnesota Board of Pharmacy, said there isn’t enough data yet to determine if the program is successful, but he’s seen anecdotal evidence that it has been.
“I’ve heard from a number of different prescribers that they’ve caught people trying to doctor-shop and not dispensed medication to them,” he said.
He acknowledged that participation in the program is lower than it should be. If a doctor isn’t registered to use the database, they can’t check it before writing a prescription.
“When more people are enrolled and use the system, it will be far more effective,” he said.
Wiberg said he doesn’t want to require physicians to check the database before writing a prescription.
“It would have a chilling effect,” he said. “It’s the amount of time involved. If you have to check for every single patient you write a controlled substance prescription for, there’s going to be a tendency to say ‘You know what, I think Motrin will work,’ even though it might be appropriate to prescribe the narcotic.”
So how does a physician know a patient isn’t
doctor-shopping if the database isn’t being checked?
“The vast majority of prescriptions, I think, are totally legitimate prescriptions for legitimate patients who are not doctor-shopping,” he said.
He said he might support laws similar to those in other states that require prescribers to check monitoring databases if red flags come up with their patients.
“But a blanket to check it all the time would require a tremendous amount of work into the health-care system, and you wouldn’t necessarily get that much benefit from it,” Wiberg said.
Getting more doctors to use the Prescription Monitoring Program is one of the primary recommendations to reduce opiate addiction made in the “Minnesota Substance Abuse Strategy,” in addition to better training for physicians and health-care providers on narcotic prescriptions.
“The strategy says: No matter what you are doing at least, do these things,” Falkowski said. “These are the things that are evidence-based, these are the things that are working. It is a blueprint for the future.”
Dr. David Schultz, the founder and medical director of the Minneapolis-based MAPS Medical Pain Clinics, said success in lowering addiction will come when doctors who prescribe narcotics take more responsibility for reducing diverted drugs.
“The high prescribers of opiates — those are the ones that should feel more responsible for maintaining control, to make sure that they’re not inadvertently supplying drug dealers or feeding addiction,” Schultz said. “They should be held to a more rigorous standard to do something to make sure that these patients are legitimate.”
Pioneer Press reporter Christopher Snowbeck contributed to this article.